Question
Now that we have the NPI number, do we stop using Medicare and Medicaid numbers?
Answer
Yes. Medicare will have a good idea of who you are with your NPI number simply by virtue of they were the ones to issue it to you. (However, I recently came across a bulletin that said you need to crosswalk your Medicare number with your NPI number to ensure that your state level carrier knows who you are.) Your Medicaid, however, is a little different story in that you may need to notify your state Medicaid Office that this was your old Medicaid Provider Number and this is your new NPI number and you're going to start using it now in the claims so that it will recognize you as one in the same person.
For all third-party payers, you've got to notify them and reference your old provider number to the third-party payer and with your new NPI number in order for them to recognize who you are. With private, commercial third-party payers, don't just start using your NPI because they'll have no clue who you are. You've got to notify them that you have this number now and make sure that they have cross-referenced it.
The ENTs in our office do not participate with Medicare. Can you provide any insight?
There are providers who do not participate in Medicare, and that does not mean you cannot see Medicare patients, but that does mean that you are under a different set of rules to do so. You're called non-participating providers. What I recommend to you is to go to the CMS web site - cms.hhs.gov - and in the search box type in non-participating providers, and it will give you a broad generalization of guidelines that you need to abide by in order to know what to do and what not to do to remain right with Medicare.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
